Health concerns and lifestyle choices linked to increase in number of people turning to IVF

Many people spend their younger years trying not to get pregnant, assuming parenthood will be waiting when they are ready. But more people are now finding it difficult to conceive when they want to and turning to medical help to have a family. The spotlight has largely been on the fact couples are delaying baby-making for career, financial and travel reasons. Half of Australian women now have their first baby over the age of 30, compared to a quarter 30 years ago. And while the chances of having a healthy baby are certainly diminished by a woman’s age (more so than a man’s), it is becoming increasingly evident that it is only part of the story. Experts say we are becoming generally less fertile and less readily able to breed, even at younger ages, and the trappings of modern life seem to be to blame. Roger Hart, professor of reproductive medicine at the University of WA, said sperm count was “the canary in the mine” for a man’s health. “There is evidence to show unfortunately, that if you require fertility treatments, you will have higher chance of later life, poor health and risk of premature death which is quite extraordinary,” he said. “It’s generally something that’s really sort of dismissed as not being all that important. But I do think that fertility is actually a marker of lifelong health.” Professor Hart said it has now got to the point that declining fertility and the postponement of parenthood is causing Australia’s birth rate to go down. “Our population would effectively be shrinking if it wasn’t for immigration,” he said. One in six couples have difficultly conceiving, according to The Fertility Society of Australia. The latest data shows there is one child born through IVF (in-vitro fertilisation) in every classroom in Australia, and every 10th baby born to a woman over 35 is conceived via this method. More than 4800 WA women had IVF treatment last year, a 4 per cent increase on the previous 12 months. There was also a 5 per cent jump in the number of IVF procedures, with 7307 cycles carried out last year. This came after a 20 per cent increase in WA women having IVF in 2018-19 following the opening of clinics offering low-cost or Medicare bulk-billed fertility treatments. Almost 27,800 embryos are frozen and stored in clinics across WA. Despite being a $535 million industry in Australia, IVF and assisted reproductive technology is not the silver bullet for infertility. In fact, fewer than one in five IVF cycles result in a baby being born. Why are we struggling to reproduce? There is an increasing evidence that the amount of sperm produced by men, particularly in Western countries, including Australia, has plummeted in recent years. Professor Hart studied the sperm quality of 423 young WA men in 2015 and found most of them had, as he put it, “terrible sperm”. Only 14 per cent — or 52 — of them had sperm which met all criteria set by the World Health Organisation to be considered fertile. “We speculated that there are other factors, that could be we are getting less healthy and there are other things within the environment, which may be influencing sperm counts,” he said. Professor Hart, medical director of Fertility Specialists of WA, said it was “staggering” to also find that these men had poorer sperm on average than men who were fertility clinic patients. In 2018, Israeli epidemiologist Hagai Levine led a review of 185 studies of almost 43,000 men who provided semen samples from 1973 to 2011. Dr Levine concluded there had been a significant decline in sperm counts over that time, with a 50 to 60 per cent drop among men from North America, Europe, Australia and New Zealand. A co-author of that review, Shanna Swan, a professor of environmental medicine and public health in the US, said if that curve continues, there will be median sperm count of zero by 2045. “It is speculative to extrapolate, but there is also no evidence that it is tapering off. This means that most couples may have to use assisted reproduction,” she told The Guardian in March. Professor Swan has been researching the impact of chemicals in plastics on fertility and reproductive health for 20 years. Her studies have shown declining fertility in younger women, and have linked chemical levels in pregnant women with hormone disruption and impaired fertility in their children. Professor Swan says phthalates — chemicals used to make plastics more durable — are the biggest concern because they are used in food packaging and therefore enter our bodies through what we eat. Phthalates lower testosterone, affecting men’s sperm count primarily but also women. The other baddie is Bisphenol A, which is used to harden plastic and is found on till receipts and inside food cans. BPA mimics the female sex hormone, oestrogen, and affects women’s fertility primarily, as well as men’s. Professor Hart led a University of WA and Women and Infants Research Foundation study that suggested in 2014 that phthalates and BPA affected unborn babies’ reproductive organs by raising their mother’s oestrogen levels. The research, which looked at Perth women and children in the Raine longitudinal study, said those higher levels can cause girls to go into puberty early and have smaller ovaries. The study found that if pregnant women had higher levels of oestrogen at the time of childbirth, their male babies were more likely to have a lower sperm count as adults. But not everyone agrees with these findings. Tim Moss, professor of obstetrics and gynaecology at Monash University, believes the evidence is not strong enough and could show association but not the cause of declining sperm counts. Writing for The Conversation this month, Professor Moss said the 2017 study observed sperm count decline among “Western” men (including Australians) but not among men from South America, Asia or Africa. “Many studies from different parts of the world show declining sperm counts, which is concerning, but we don’t fully understand the reasons for the apparent decline,” he said. “Blaming chemicals in the environment overlooks other important factors such as chronic disease, diet, and obesity, which people can act on to improve their fertility.” Stephen Junk, scientific director at Fertility North, said the impact of chemicals in our environment and women putting off child-bearing were equal main reasons for declining fertility and more people seeking assisted reproduction treatment. “We suspect there’s a lot of environmental factors involved. The increased use of plastics and detergents and chemicals in the environment over the last 30 to 40 years has to have had an effect,” he said. “If you look at animal models, there certainly is an impact on fertility with plastics and chemicals. So one would expect that you’d see the same thing in humans.” He said it was well-known in the scientific world that plastics, particularly when heated up, can leach chemicals into food which can then affect fertility, sperm and embryonic development. Dr Junk said he saw people with certain lifestyles suffer particular fertility issues, such as farmers with low sperm counts, because of chemical exposure. “Certainly, it does get involved with the endocrine (hormone) system and so, therefore, it will affect the sperm production and also not just the sperm production, but the ability of the sperm to do the right thing when it gets to an egg,” he said. Sarah Hack and her husband Dave were shocked to find out he had a low sperm count in tests they had after failing to conceive naturally for a year. “He’s not overweight or anything like that. He looks like a very healthy man,” Mrs Hack said. Mr Hack, 34 at the time, took supplements, improved his diet and cut back on coffee and alcohol, and his sperm count increased significantly, but the couple still did IVF to conceive. Mrs Hack said she knew very little about it at the time and felt embarrassed about needing help to conceive. “I just didn’t want that to be my story. I didn’t want that to be how we had our children,” she said. But now she thinks the “science is awesome” and is grateful to have had the opportunity to use it to have daughters Goldie, 2, and three-month-old Stella. “Our story does provide a bit of hope for people who are about to go into it. Not unrealistic expectations, just a sense of hope it can work out really well,” she said. Dr Junk said he believed exposure to plastic and chemicals could be more damaging to women who develop their lifetime supply of eggs at nine weeks in utero. “Those eggs have been exposed to a lot during their lifetime, while their mum was pregnant, as well as all the things which have happened throughout your lifetime until you decide to have children,” he said. But Dr Junk said the effect was more likely to be able to be reversed in men, who produce new sperm every 72 days. Jaime Richardson was only 32 when she was diagnosed with low ovarian reserve after suffering four miscarriages from natural conceptions. “It was a difficult time for sure because you get your hopes up. Once is fine, it happens all the time and you don’t really think much of it,” she said. “Then it happens again, you think, ‘Twice is weird but we’ll just keep on going’, and then three, and then four. You go through this rollercoaster ride of excited and devastated and excited and devastated.” Mrs Richardson and her husband Adam only produced one embryo from two rounds of IVF, which fortunately resulted in their 19-month-old daughter Juliet. They then conceived again naturally twice, only to miscarry both on Juliet’s first birthday and around Christmas last year. Earlier this year they did IVF after Mrs Richardson gave up sugar and caffeine — and had acupuncture twice weekly — for three months in a bid to improve her egg quality. To the couple’s delight, the IVF cycle produced four embryos which were deemed chromosomally normal. Mrs Richardson said poor egg quality appears to run in her family. “My mum had multiple miscarriages. Her mum had a stillborn. My sister had multiple miscarriages. So there’s potentially a link,” she said. Professor Hart urged men and women not to try to get pregnant until they were as optimally healthy as they could be. “Minimise your exposures to environmental contaminants as much as possible, and just eat sensibly and be healthy,” he said. “For women, it doesn’t mean massive over-exercising. We think being healthy means running, but it’s not. It’s just having a normal body mass index and doing some regular form of exercise but not overdoing it. “For the man, it’s just trying to keep his weight under control, minimal alcohol, no smoking, eating healthily, not pre-packaged foods but fresh vegetables. It’s a simple message.” Dr Junk said schools should give young people information on ways to improve reproductive health, such as evidence of the impact of chemicals and delaying childbirth. “It’s something you should be thinking about from the time of having sex education. As well as looking at what your career is going to be, you should be looking at your reproductive career as well,” he said. Dr Junk said as confidence in IVF and assisted reproductive technology had grown, so had people’s reliance on it. “It’s more of a routine procedure than it was many years ago, so people think it doesn’t really matter if they’re having issues at the moment, they’ll get on with their career or whatever and then try later on, because the IVF will solve things,” he said. “But we can only deal with what we’ve got.”